Increased leukemias near nuclear power stations

Dr Ian Fairlie Consultant on Radiation in the Environment London United Kingdom

Childhood Leukemias near Nuclear Facilities      in 1980s -90s, increases found near UK nuclear facilities (Dounreay, Windscale, Burghfield) Also in Germany, increased incidence at Kruemmel UK NRPB said not due to radiation as doses were too low x 300 But no-one had expertise to challenge this Reay v BNFL – plaintiffs lost a very large case

KiKK Report in Germany in 2008 K inderkrebs i n der Umgebung von plants. Int J Cancer 122:721–726.

K ern plants in Germany 1980–2003. Eur J Cancer 44:275–284.

K raftwerken Kaatsch P, Spix C, Schulze-Rath R, Schmiedel S, Blettner M. 2008. Leukaemias in young children living in the vicinity of German nuclear power Spix C, Schmiedel S, Kaatsch P, Schulze-Rath R, Blettner M. 2008. Case–control study on childhood cancer in the vicinity of nuclear power • reignited the leukemia debate • large controversy in Germany • almost unknown in UK

KiKK Study: 2008

      very large study of cancer incidence near all (16) German nuclear power stations commissioned by German Government 1.2 x increase in child leukemias 0.6 x increase in embryonal cancers strongly linked to proximity to reactors validity accepted by German Government

the closer to reactor – the greater the risk of child leukemia Kaatsch et al., Int J Cancer, 2008

Do Other Studies Back up KiKK?

Yes.

(1) Laurier D et al (2008) Epidemiological studies of leukaemia in children and young adults around nuclear facilities: a critical review. Radiat Prot Dosimetry 132(2):182-90. REVIEWED 26 MULTI-SITE STUDIES (2) Laurier D, Bard D (1999) Epidemiologic studies of leukemia among persons under 25 years of age living near nuclear sites. Epidemiol Rev 21(2):188-206. LISTED 50 STUDIES (36 SINGLE AND 14 MULTI-SITE) ie over 60 STUDIES

What do 26 latest studies show?

from table 1 of Laurier et al (2008) All 26 Studies Studies statistically significant at 95% level Leuk increase observed 19 6 No Leuk increase observed* 7 1 % observed 73% 85% * Absence of evidence does not mean evidence of absence Conclusion: a steady pattern of leukemia increases near NPPs

What are possible causes?

      Confounders Coincidence Population mixing Exposure to chemicals Exposure to viruses/fungi Exposure to radiation X X X X X ?

KiKK stated radiation doses were too low, but without supportive estimates

But there are large uncertainties in the estimated doses/risks near reactors OFFICIAL ESTIMATES OF DOSES/RISKS HAVE MANY UNCERTAINTIES see CERRIE Report www.cerrie.org

Why the large uncertainties?

Because they use many dose models  Environmental models (behaviour of nuclides in environment)  Biokinetic models (uptake and retention of nuclides in humans)  Dosimetric models (convert Bq to mGy: mSv)  Dose weighting factors (tissue W T and radiation W R )

Why the large uncertainties?

Because an inappropriate risk model is used  Official ICRP risk model is based on data from 1945 Japanese bomb survivors  Is this appropriate for environmental exposures from NPPs?

 Higher risks in infants?

 Higher risks from in utero exposures?

Uncertainty distributions in dose estimates

Uncertainties in Dose Coefficients Goossens LHJ, Harper FT, Harrison JD, Hora SC, Kraan BCP, Cooke RM (1998) Probabilistic Accident Consequence Uncertainty Analysis: Uncertainty Assessment for Internal Dosimetry: Main Report. Prepared for U.S. Nuclear Regulatory Commission, Washington, DC 20555-0001, USA. And for Commission of the European Communities, DG XII and XI, B-I049 Brussels Belgium. NUREG/CR-6571 EUR 16773.

Nuclide Intake Organ

Cs-137 ingestion Pu-239 ingestion red bone marrow I-131 inhalation thyroid Sr-90 ingestion red bone marrow Pu-239 ingestion Sr-90 red bone marrow inhalation lungs Ce-144 inhalation red bone marrow bone surface

U Range = (ratio of 95 th /5 th percentiles)

4 9 240 1,300 5,300 8,500 20,000

So, radiation exposures to nearby people could be a cause

KiKK: cancer increases strongly associated with proximity to nuclear reactors     direct radiation from reactors?

EM radiation from power lines?

X X cooling tower emissions?

reactor emissions and discharges?

X

Hypothesis to explain KiKK findings  episodic spikes in reactor releases  high concentrations in pregnant women  large doses to embryos/fetuses  resulting babies are born pre-leukemic  after 1-2 years develop full leukemia

Leukemogenesis in Children

(after Professor Roessig) 1st hit 2nd hit Bone marrow Stem cell In Utero Preleukemic clone Birth Leukemic cell Post-Natal

1 st Stage – Environmental Emissions  

when reactors opened - large pulse of radioactive gases H-3, C-14, Kr-85

Spikes in radioactive releases

Tritium doses from ingestion (EU RODOS Model) in mSv 8th Meeting of the IAEA (EMRAS) Tritium & C-14 Working Group May 30 - June 1, 2007 - Bucharest, Romania (http://www.nipne.ro/emras/)

Estimated tritium levels in cow’s milk (EU RODOS Model) OBT Bq/kg 8th Meeting of the IAEA (EMRAS) Tritium & C-14 Working Group May 30 - June 1, 2007 - Bucharest, Romania (http://www.nipne.ro/emras/)

re Embryos/fetuses: we don’t know (a) their radiation doses?

(b) how radiosensitive are they ? (c) risks from internal nuclides?

Ask governments for their estimates of doses/risks to embryos, + the uncertainties involved ?

“We conclude that there is strong evidence that low dose irradiation of the fetus in utero , particularly in the last trimester, causes an increased risk of cancer in childhood.” Doll R and Wakeford R (1997) Risk of childhood cancer from fetal irradiation. Br J Radiol; 70: 130-9

Main Radioactive Releases to Air from Nuclear Facilities      tritium (radioactive water vapour) noble gases (including Kr, Ar, Xe) plus smaller amounts of carbon-14 iodine-131, iodine-129 … and very small amounts of other nuclides

Tritium in air

Tritium in Food Moisture

What is tritium?

 the radioactive isotope of hydrogen  mostly in the form 3 H-O-H  Ie tritium is radioactive water  undetected by any of our senses

Unusual Tritium Properties

    Extreme mobility + exchangeability Sticks inside us, and builds up Very short range, so damage depends on location in cell, eg close to DNA?

Tritium described as “weak”, but more dangerous than “strong” emitters RESULT: Official models significantly underestimate its doses and its hazards

List of Hazardous Properties

(after Dr Gerald Kirchner) Tritium = √ Carbon-14 = √ 1. large releases to environment √ √ 2. rapid nuclide transport and cycling in biosphere √ √ 3. high solubility √ √ 4. many environmental pathways to humans √ √ 5. rapid molecular exchange rates (ie very fast intakes) √ 6. high uptake to blood after intake √ √ 7. organic binding in biota √ √ 8. long biological half-life in humans √ √ 9. long radiological half-life √ √ 10. global distribution √ √ 11. long nuclide decay chains with radiotoxic daughters 12. high radiotoxicity (ie high dose coefficient)

Apply the Precautionary Principle

    uncertainty not an excuse for inaction if reasonable evidence, should take precautionary steps eg health warnings near reactors?

whatever the explanation for KiKK, the raised leukemia risk is still there

Recommendations

    Further studies (EU wide) Advise local people of risks Health warnings near reactors Rethink plans to build more reactors in some countries (UK, France, US)

Thanks for comments to Dr Alfred

Körblein Dr Philip Day (who sadly passed away in 2010) Dr Keith Baverstock (Of course, any errors which remain are my responsibility alone)